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1356410104

NPI Code Detail

MEDICARE: DR. MARTIN A RUIZ MD

MEDICARE: DR. MARTIN A RUIZ MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD2006-0679	NM
2	207R00000X	Internal Medicine Physician	S8382	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM001P94	OTHER	NM	BCBS NM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356410104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIN A RUIZ MD

Provider Business Mailing Address
First Line	:	2332 BEVERLY HILLS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-1756
Country	:	US
Telephone Number	:	817-625-4254
Fax Number	:	817-378-0861

Provider Business Practice Location Address
First Line	:	2332 BEVERLY HILLS DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76114-1756
Country	:	US
Telephone Number	:	817-625-4254
Fax Number	:	817-378-0861

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	10/09/2024

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Directions to “ DR. MARTIN A RUIZ MD” Practice Location

Language	Start Address	Practice Location

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